Experience

HealthSmart

• United States
• Insurance and Employee Benefit Funds
• 300 - 400 Employee

• Provider Relations Representative

  • May 2016 - Present

  Assist in the overall education operations to providers • Initiate responses to provider request/needs • Negotiate provider contracts as applicable • Directs contracts to providers wanting to join the network/nominations • Communicate any new and updated policy and procedures to providers • Update and maintain tracking log of each facility and provider info • Review contracts for discrepancies • Assign work task to credentialing specialist • Scrub applications files before sending to credentialing Show less



20/20 Staffing

• Irving, Texas

• Provider Relations Rep

  • Oct 2015 - May 2016

  20/20 Staffing Irving, Texas HealthSmart October 2015- May 2016 Provider Relations Rep Assist in the overall education operations to providers • Initiate responses to provider request/needs • Negotiate provider contracts as applicable • Directs contracts to providers wanting to join the network/nominations • Communicate any new and updated policy and procedures to providers • Update and maintain tracking log of each facility and provider info • Review contracts for discrepancies • Assign work task to credentialing specialist • Scrub applications files before sending to credentialing Credentialing Coordinator Communicate credentialing requirements and documents as needed. Maintain knowledge of jurisdictional requirements and document credentialing changes as needed. Ensure credentialing, full or mini, for designated contractors in an organization. Interpret, create and load provider contracts and fee schedules on accounts assigned • Develops and maintains credentialing, regulatory and profiling information. • Participates in quality monitors and compiles information and reports for the Medical Advisory Committee and the Internal Quality Committee. Participate in implementation of new networks and employer groups. • Performs initial and re-credentialing activities in order to review providers for quality issues. • Receives, researches and answers calls from provider offices regarding credentialing and other quality issues. • Conducts the Member Satisfaction quality component of credentialing. • Maintains quality data to be integrated in credentialing and re-credentialing. • Creates reports related to credentialing productivity and provider profiling and completes other quality projects as assigned by Credentialing Manager. Show less



WebTPA

• United States
• Insurance
• 200 - 300 Employee

• Provider Maintenance Coordinator

  • Jun 2014 - Oct 2015

  Ensure all provider and vendor records are upheld following industry wide standards and handled with confidentiality and accuracy.with confidentiality and accuracy. • Interpret, create and load provider contracts and fee schedules on accounts assigned • Provide customer service to any external clients, networks, providers, claims and account management departments • Pull reports from Access and transfer to Excel spreadsheet for processing • Participate in implementation of new networks and employer groups • Process related informational data and forward to appropriate personnel for approval • Use multiple resources for research to verify provider accuracy such as npi databases on web • Comply with data integrity, security policies, confidential handling Show less



Pier 1

• United States
• Retail
• 700 & Above Employee

• Customer Relations

  • Oct 2014 - Jan 2015

  Customer Relations – Ecommerce Seasonal Answered a high call volume from customers and store personnel. Responsible for assisting with any ecommerce issues or inquiries. • Assisted in placing online orders • Troubleshoot any error messages received • Tracked orders • Product search • Refund on orders not received, damaged items, and price adjustments • Documented and tracked any complaints and product issues • Identified and reported trending issues with ecommerce Show less



Citi

• United States
• Financial Services
• 700 & Above Employee

• Collector III Personal Loans

  • Apr 2014 - Jul 2014

  Contact customer who are delinquent in the repayment of their loans and collect payment. • Accountable for reducing delinquency for assigned accounts • Meet or exceed department goals and metrics • Gain commitment for repayment • Negotiate settlements • Qualify clients for assistance programs • Document accounts for follow-up and reviews • Process and review account adjustments • Advise customers of necessary actions and strategies for debt repayment within state guidelines Show less



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Senior Claim Benefit Processor

  • Jun 1999 - Feb 2013

  KEY ATTRIBUTES: • Excellent communication Skills • Computer and technical literacy • Able to multitask job assignments, organization and planning • Work well in either an independent environment or as a team contributor • Self motivated to learn new skills. • Knowledge of managed care/ppo/traditional choice/epo/hmo products • Knowledge of provider contracts • Knowledge of ICD9/ICD10/CPT/HCPC coding • Eligibility verification QUALIFICATIONS: • Worked on special projects • Monitored several mailboxes • Distributed work assignment to junior staff • Trained and mentored benefit claim specialist • Performed claim rework calculations • Reviewed pre-selected claims • Reviewed high dollar claims • Applied medical necessity, timely filing, determined coverage Show less